Are Pre-Policy Medical Check-Up and Tests under Health Insurance Coverage Important?

Posted on: May 25, 2022 | | Written by:

Are Pre-Policy Medical Check-Up and Tests under Health Insurance Coverage Important?

For majority of health insurance policies, pre-policy medical tests are compulsory. These tests are important because they act as a yardstick against which the insurance company can measure the policyholder’s health. In case, any pre-existing medical conditions and illnesses are detected through such a test, the insurance company takes a decision on appropriate cover for the particular individual. For filing claims, these tests are important. For example, if a policyholder files a claim and the company can prove that the illness was caused by a pre-existing medical condition that was not declared or proves that the policyholders intentionally withheld information regarding his/her medical health, the claim could be rejected. By undergoing a pre-policy test, the policyholder’s medical health will be on record, making it easier for both the insurance company as well as the policyholder to examine and file a claim, respectively.

Which tests are usually conducted?

Every insurer has a different risk assessment policy; based on which ainsured person’s medical risk is measured. The risk is measured by a framework, with the policyholder’s age and coverage amount being the benchmark of the framework. On the basis of these two factors, the type of tests would be administered to the policyholder. The usual tests conducted are for blood pressure, ECG, lipid profile test, blood serum test, complete blood count, blood sugar etc.

Who bears the cost for the tests?

According to Insurance Regulatory and Development Authority of India (IRDAI) rules, at least half of the expenses of the tests are to be paid by the insurance company, and the balance is to be paid by the policyholder. But due to competition and to decrease the burden on policyholders, many insurance companies choose to bear the cost of the tests themselves. There are also some health insurance policies where the policyholder has to bear the costs of the pre-policy testing, and later the amount is reimbursed after the cover has been approved.

What happens after the tests are conducted?

Once the results come, the insurance company will decide on the coverage of the policyholder as per the terms and conditions mentioned in the policy proposal. If the tests show an illness or medical condition, the company maydecide on for any of the following:

• Higher premium:

The company can issue the policy to the individual but at a higher premium to cover the expenses that may incur becauseof the condition/illness detected. The increase in premium would depend on the seriousness of the illness and the policyholder’s age.

• Exclusions:

In some cases, even though the insurance company decides to approve the policy, they might exclude certain covers for the condition/illness detected. This is done if the company’s underwriters consider the illness too risky to be covered. In such a case, if the policyholder receives any medical treatment due to the excluded illness, he/she will not be able to file a claim of recompense.

• Rejection:

For cases where the illness is extremely risky or would require frequent treatment, the insurer could choose to reject the policy proposal.

Conclusion

There are policies that do not require pre-policy medical examinations, but it is advisable to undergo the tests as they pay dividends in the long run and help avoid the possibility of claim rejection. The most important thing to do is buy the best health insurance in India. While buying a policy, you need to do a thorough research and choose the best health insurance in India. Only the best health insurance policy will help protect you and your family financially during health emergencies.

Disclaimer: The above information is for illustrative purpose only. For more details, please refer to policy wordings and prospectus before concluding the sales.

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